Cervical myelopathy (CM) is a progressive disorder arising from sustained pressure placed on the spinal cord in the neck. The direct answer to whether CM can cause paralysis is yes, particularly if the condition is left untreated. Understanding the mechanism of this compression and recognizing its subtle signs are the first steps toward preventing severe and irreversible functional loss.
Defining Cervical Myelopathy
Cervical myelopathy is a neurological syndrome resulting from sustained compression and injury to the spinal cord within the neck (cervical spine). The term “myelopathy” denotes a functional disturbance or pathological change to the spinal cord that interferes with nerve impulse transmission. This condition is frequently caused by age-related changes, often referred to as cervical spondylosis or degenerative cervical myelopathy.
Chronic pressure on the spinal cord stems from several degenerative issues. These include the formation of bone spurs (osteophytes) and the thickening or ossification of ligaments surrounding the spinal canal. Intervertebral discs may also bulge or herniate, reducing the space available for the spinal cord and leading to a narrowing called spinal stenosis.
Recognizing the Signs of Cord Compression
The initial symptoms of cervical myelopathy are often subtle, making early diagnosis challenging as they can be mistaken for normal aging. Cord compression manifests in several key ways:
- A noticeable loss of fine motor skills in the hands, making simple tasks like buttoning a shirt or picking up small coins increasingly difficult.
- A change in the way a person walks, known as a myelopathic gait, which presents as a clumsy, unsteady, and wide-based walk.
- Sensory disturbances, including numbness, tingling, or a pins-and-needles sensation in the hands and feet.
- Changes in reflexes, specifically hyperreflexia, where reflexes are exaggerated below the level of compression.
The Risk of Permanent Functional Loss
While sudden, complete paralysis involving all four limbs is uncommon, it remains a risk if cervical myelopathy progresses without intervention. The danger of untreated CM is the steady neurological deterioration that leads to severe functional deficits. Chronic compression damages the spinal cord through mechanical injury, reduced blood flow (ischemia), and localized inflammation.
This sustained pressure causes the death of nerve cells and permanent deterioration of spinal cord tissue. This irreversible damage results in severe weakness, loss of coordination, and spasticity in the limbs. In advanced cases, damage may extend to autonomic pathways, leading to a loss of bladder and bowel control.
Management and Treatment Options
A diagnosis of cervical myelopathy begins with a detailed neurological examination and is confirmed through advanced imaging. Magnetic resonance imaging (MRI) is the preferred tool because it clearly visualizes the spinal cord and soft tissue structures, revealing the extent of compression and internal changes. X-rays and CT scans may also be used to assess the bony anatomy and stability of the cervical spine.
For mild cases, non-surgical management, such as physical therapy or anti-inflammatory medications, may be considered. However, these approaches rarely address the underlying anatomical compression.
For moderate to severe myelopathy, or for cases that continue to progress, surgical intervention is generally considered the definitive treatment. The goal of surgery—which may involve procedures like decompression surgery, laminectomy, or laminoplasty—is to physically remove the source of pressure on the spinal cord. Relieving this pressure halts the progression of neurological damage and prevents further functional loss. The prognosis is better when the condition is identified and treated early, as recovery of function already lost is variable and not guaranteed.